DESCRIPTION OF THE STRATEGY

The intervention known as behavioral family therapy (BFT) has its origins in the convergence
of two broad theoretical traditions: the behavior and family therapies. The plural behavioral
therapies indicates an intellectual journey of increasing theoretical sophistication and range of
applications during the half century or so since operant and classical conditioning principles
of learning were first applied systematically to children's clinical problems. Applied behavior
analysis, behavior modification and therapy, cognitive behavior therapy, marital behavior
therapy, and behavioral play therapy have all contributed to present-day BFT. Among the
seminal influences (described later) on the development of its theoretical and practical
foundations are those of Albert Bandura at Stanford University and Gerald Patterson at the
Oregon Social Learning Center.
The systemic family therapy influence in the development of BFT is difficult to specify
precisely. There is no one therapeutic entity that defines family therapy; there are several
models or schools. The structural school, which had its origins in the work of Salvador
Minuchin in the 1960s, and strategic family therapy, which had its beginnings in the Palo Alto
research group led by Gregory Bateson in the early 1950s, have elements of philosophy and
methodology in common with behavioral approaches to childhood and adult psychopathology.
Given the rich but diverse theoretical and applied origins of BFT, it is not surprising that
marking out clear conceptual boundaries is so difficult. Perhaps the best way of describing
BFT is as a behaviorally orientated therapeutic endeavor that (a) focuses on changing the
interactions between or among family members, (b) seeks to improve the functioning of
individual members, also (c) the relationships within particular groupings (subsystems such as
parent and child, husband and wife), or (d) the interactions within the family as a unit. What
unites most family therapies as they engage in their divergent treatment strategies is a
perspective that requires that children's problems be understood as the consequence of the
pattern of recursive behavioral sequences that occur in dysfunctional families.
This perspective, influenced by a general systems or cybernetic paradigm, was originally
conceived by Von Bertalanffy in the late 1920s in an attempt to understand living organisms
in a holistic way. It was many years later, in the 1950s, that practitioners applied his ideas to
work with families. These ideas embrace the concept of reciprocal/circular causation in which
each action can be considered as the consequence of the action preceding it and the cause of
the action following it. No single element in the sequence controls the operation of the
sequence as a whole because it is itself governed by the operation of the other elements in the
system. Thus, any individual in a family system is affected by the activities of other members
of the family, activities which the individual's actions or decisions, in turn, determine.
Similarly, in the behavior therapy idiom, an individual's behavior functions as both stimulus
and response. The ABC analysis (at the core of the learning equation in behavior therapy) is
elaborated into a nonlinear recursive sequence. A stands for antecedent events, B stands for
the target behaviors or beliefs (the child's and/or parent's interpretation of events), C stands
for the consequences that flow from these behaviors/beliefs. Cs (in their turn) become As
(triggers), which generate new Cs (outcomes), and thus generalize to affect the actions of
others in the vicinity of the main protagonists (e.g., siblings, parents, and child).
This sequence is called a functional analysis, and in BFT is directed toward the precise
identification of the conditions that control the targeted behavior problems and the effects that
follow. At its simplest, the important questions are, What events trigger (elicit) the phobic

fear? or What reinforcement or payoff does the child get for behaving in an aggressive
manner? or What are the overall ramifications of these events? At a more interpretive level,
the child's behavior may have the function of solving (or attempting to solve) a developmental
or family problem. They serve a purpose, and in this sense are functional (though they may
appear dysfunctional to the parent or professional) for the individual. An example of this is to
be seen in the case illustrated below where a child would rather provoke negative attention
than receive no attention at all.
One of the basic premises of BFT is that behavior is precipitated by particular setting events
and maintained by its consequences. Another is that much abnormal behavior and cognition is
on a continuum with normal behavior and thinking, and as such, is subject, with some
important exceptions, to the same laws of learning. Unfortunately, the very processes that help
a child adapt to life can, under certain circumstances, contribute self-defeating behaviors. An
immature child who learns by imitating an adult does not necessarily comprehend when it is
undesirable (deviant) behavior or distorted thinking that is being modeled. The youngster who
learns adaptively to avoid a dangerous situation (and ones that are similar) on the basis of a
traumatic fear reaction and the relief of escaping from it can also learn by the same processes
(classical and operant conditioning, respectively) to avoid school or social gatherings. A
caregiver may also unwittingly reinforce inappropriate behavior by attending or giving in to
it.
BFT practitionersprofessionals with specialist training from mainly the mental health and
social servicestypically engage more than one family member (whole families, marital or
cohabiting partners, or parents and child) in face-to-face treatment. Therapy could also
involve a single person for all the sessions. Patients are encouraged by a variety of therapeutic
strategies to understand the alliances, conflicts, and attachments that operate within their
family unit. They are encouraged to seek alternative solutions to their dilemmas and to feel
and act differently in order to see themselves from a new perspective. BFT interventions with
children and adolescents make use of techniques drawn from behavior therapy: operant
procedures, desensitization, exposure training, social skills training, role play, behavior
rehearsal, modeling, relaxation, homework exercises, and self-monitoring. Other methods
have their roots in cognitive-behavioral and cognitive therapy: Socratic questioning,
persuasion, challenging, debate, hypothesizing, cognitive restructuring (reframing), verbal
self-instruction, and internal dialogues. Given the intimate relationship between BFT and
social learning theory, there is a strong focus on social influence, social cognitions, and early
attachments.
Behavioral parent training (BPT) is a highly effective group-based intervention that comes
under the rubric of BFT. It addresses parents' or other caregivers' difficulties in managing
seriously disruptive behavior. Parents of youngsters with conduct problems give more
frequent, negative, and ineffectual commands than parents of nonproblematic children. They
tend to flounder because they provide attention following deviant behavior or are unlikely to
perceive it as unacceptable; they get embroiled in extended coercive hostile interchanges and
fail to monitor their children's activities or communicate effectively with them.
Parent training programs are designed to reduce confrontations among members of the family,
increase their positive interactions, and moderate the intensity of punishment meted out by
parents. Parents are guided in the implementation of brief, mild, nonphysical sanctions such
as planned ignoring, time-out, loss of privileges, and logical consequences. Parents' own

experiences of being parented and of being children in their own right are discussed and
related to their beliefs (attributions) about child rearing and their attitudes to their children.

RESEARCH BASIS
Research on social learning theory, central to BFT, indicates that rewards and punishments,
and the adoption of modeled behaviors and attitudes, are not simply the impersonal
consequences of behavior. They are mediated by human agents and within attachment and
social systems. The result is that children do not simply respond to stimuli; they interpret
them. They relate to, interact with, and learn from people who have meaning and value for
them. They feel antipathetic to some, attached by respect and/or affection to others, and thus
may perceive an encouraging word from the latter as rewarding (i.e., positively reinforcing),
but from the former as valueless, perhaps even aversive. Stimuli influence the likelihood of
particular behaviors through their predictive function. Salient (contingent) experiences create
expectations rather than simple stimulus-response connections.
Patterson's research has highlighted a critical feature of the interactions in families with
disruptive children, namely coercion. In a coercive interaction, the aversive behavior of each
person is terminated or reduced in frequency by the aversive behavior of the other person, but
the long-term effect is to increase the likelihood that the original aversive behavior will occur
again. For example, a parent orders a child to go to bed and she or he objects by whining
incessantly. If the frustrated parent takes the line of least resistance and stops insisting, the
child's whining is reinforced by the removal of the unwanted demand. The parent's reaction of
dropping the demand is also (negatively) reinforced when the child stops the aversive
whining. The net result of this commonplace scene from everyday life is that both the bedtime
whining and the parent's retreat are more likely to be repeated on future occasions. If left
unchanged, these coercive patterns of interaction may continue in magnified form into school
life and adulthood.
It has been found that a collaborative style of working in BFT that gives parents responsibility
for developing solutions alongside a therapist is more likely to increase their sense of
confidence (perceived self-efficacy) and self-sufficiency than are therapies that do not.
Support for this approach comes from Bandura's research literature on self-efficacy, which has
been shown to be a critical causal (mediating) link between knowledge and behavior. Thus,
people who own outcomes and feel self-confident are more likely to persist in the face of
difficulties until success is achieved. They are also less likely to experience the debilitating
effects of stress. Collaboration implies a nonjudgmental, supportive, reciprocal relationship
based on combining the therapists' knowledge and the patients' unique strengths and
perspectives; it implies respect for his or her contribution to the treatment programs. In a
collaborative relationship, the therapist works with parents by actively soliciting their ideas
and feelings, understanding their cultural context, involving them in the joint process of
setting goals, sharing their experience, discussing and debating ideas, and problem solving
together. The collaborative process has the advantage of reducing attrition (dropout) rates
during treatment, increasing motivation and commitment, and reducing resistance by giving
both patient and the therapist a stake in the outcome of the intervention efforts.
Rigorously designed evaluations of BFT and BPT, which are more numerous than those
supporting any other approach, indicate their high level of effectiveness for treating a wide
variety of the psychological problems that affect children and families.

RELEVANT TARGET POPULATIONS AND

EXCEPTIONS
BFT has been applied to a comprehensive list of adult disorders (ranging from schizophrenia
and depression to postcombat trauma and substance abuse), life problems (e.g., marital and
personal difficulties), and child and adolescent problems (including anxiety conditions,
oppositional behavior, disruptive disorders, and delinquency). A survey of family therapists'
primary treatment goals for families produced the following list: improved communication,
improved autonomy and individuation, improved empathy, more flexible leadership,
improved role agreement, reduced conflict, individual symptomatic improvement, and
improved individual task performance.
Because the frontiers of BFT are still expanding, it is difficult to say which problems are not
amenable to the method. The range of problems has been broadened by an informed (as
opposed to ragbag) eclecticism, which, for many practitioners, encompasses behavioral play
therapy, functional and strategic therapy, and cognitive-behavioral approaches. The adjunctive
role of marital behavior therapy enhances parent training outcomes and represents a further
widening of the BFT repertoire.

COMPLICATIONS
The question of how to adopt a standard by which to evaluate functional (healthy) as
opposed to dysfunctional (unhealthy) patterns of individual behavior or family organization,
boundaries, strategies, rules, roles, decision-making processes, communications, or any of the
other attributes family therapists believe to be significant, remains unresolved. Clearly, there
are diverse cultural norms and subjective personal values that complicate professional
judgments in these matters. There have also been disagreements over the years about the
appropriate unit of focus (whole family vs. subsystems) in family therapy. The choice today,
for most behavioral family therapists, is likely to be whichever is relevant to a problem at any
one time. Its composition may vary over time and is best decided collaboratively by
negotiation between the therapist and patient(s).

CASE ILLUSTRATION
Louise, when brought to the clinic, was a bright, assertive child approaching 4 years of age.
She was notorious among her mother's friends for her frightening temper tantrums. Jane, a
quiet, shy woman in her late 20s, was feeling increasingly helpless at her inability to cope
with Louise's aggression, and depressed about her unsatisfactory marital relationship, feelings
which she had not dared communicate openly to her husband.
The assessment at the clinic utilizes a multimethod, problem-solving approach to obtain as
complete a picture of the child and the family as is possible. The strategy is to begin with a
broad-based assessment (measures of behavioral, cognitive, and emotional functioning) of the
child and her environment (e.g., family, school, peers) and then to obtain information
regarding specific stimulus features, response modes, antecedents, and consequences,
severity, duration, and pervasiveness of the particular problems. The family, as a small group,
is observed and assessed on a variety of dimensions: patterns of communication, cohesion,
and processes of decision making.

Assessment revealed that Jane had no self-confidence and a very poor self-image, particularly
with regard to her parenting. Her own mother (siding with her son-in-law) was scathing (as
we were soon to discover in conjoint interviews) about the way she spoiled Louise, giving
in to her on bedtime and table rules. A visit to the play school indicated a different child,
well liked and cooperative, except when in her mother's presence. Observations of mother and
child at play indicated that Jane was nervously intrusive in their interactions and missed
opportunities to praise her daughter's clever use of drawing materials. Home observations of
the three of them showed Louise continuously seeking attention, the father being remote, and
the mother responding inappropriately when Louise was demanding, or ineffectually when
she was being defiant. The important assessments of positives in Louise and her parents
revealed many assets on which to build change.
The clinical formulation of the clients' problem (all members of a family, in this instance)
bridges the assessment, the treatment plan, and its implementation. The contemporary causes
of problem behavior may exist in the clients' environment or in their thoughts and feelings.
They may exert their influence in several ways: as triggers that are direct in their effects and
close in time to the actions they influence, or as outcomes (consequences) of a reinforcing
kind. The identification of the current problem may be assisted by information about the
patients' past (e.g., early attachments, health, reinforcement history, attitudes, life events). The
past may haunt the present in the sense that it may influence current attitudes and thus, in turn,
actions. It may be necessary before work can begin on a behavioral program to lay such
ghosts to rest by discussing past traumatic events and their meaning.
In the present formulation, it was hypothesized (inter alia) that much of Louise's incessant
demanding was attention seeking, and associated with the relative absence of warm and
responsive attention she experienced. The lack of clear rules or limits, combined with
inconsistent parental reactions to her defiance and tempers, contributed to her lack of selfcontrol at home. These difficulties seemed to suggest the need for a parent training
intervention. Discussions with Jane alone revealed a person who had received little in the way
of confidence-boosting encouragement as she grew up. Although she loved her husband and
appreciated much that he did for her, his lack of emotional support over Louise depressed her.
Following a conjoint session with his wife, he expressed shock at her despair and low morale
and stated that he was prepared to change if it would save their marriage, something he very
much wished for.
Louise had a high score on the Richman & Graham Behavior Screening Questionnaire, but as
she was no problem whatsoever at play school, it was decided not to work directly with her.
Treatment for the parents began with three conjoint counseling sessions that addressed a
variety of issues (e.g., quality time and its importance, child development, and their own
personal backgrounds) of concern to them. Following these sessions, it was arranged for them
to begin two courses: the group-based Child-Wise Parenting Skills (CWPS) course and a
behavioral marital therapy (BMT) program that they attended as a couple on their own. Their
ratings after 10 weekly sessions of the CWPS indicated improvements at home, in skills,
confidence, and child care outcomes (managing Louise's behavior and enjoying her
company). The results of six BMT sessions at the clinic were monitored on rating forms and
evaluated qualitatively by means of diaries and written narratives. The program was evaluated
as successful in terms of criteria involving their own relationship and an effective alliance in
managing their daughter.
Martin Herbert

Further Reading

Entry Citation:
Herbert, Martin. "Behavioral Family Therapy." Encyclopedia of Behavior Modification and
Cognitive Behavior Therapy. 2007. SAGE Publications. 15 Apr. 2008. <http://sageereference.com/cbt/Article_n2017.html>.